Healthcare Provider Details

I. General information

NPI: 1023034543
Provider Name (Legal Business Name): JENNIFER LYNN ARCHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN HAMM ARNP

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6582 165TH ST
ALBIA IA
52531-8793
US

IV. Provider business mailing address

6582 165TH ST
ALBIA IA
52531-8793
US

V. Phone/Fax

Practice location:
  • Phone: 641-932-7172
  • Fax: 641-932-7174
Mailing address:
  • Phone: 641-932-7172
  • Fax: 641-932-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number105742
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA105742
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: